ACEP Emergency Department Facility Coding – Level 4 (CPT 99284)

Overview

CPT 99284 represents an Emergency Department visit involving a detailed history, detailed examination, and medical decision-making of moderate complexity. This level often involves multiple diagnostic tests, multiple interventions, or treatments requiring moderate resources and time.

• Type A: APC 615

• Type B: APC 629

• HCPCS: G0383

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Possible Interventions

Could include interventions from previous levels, plus any of:

• Oxygen by mask/nasal cannula

• Multiple nebulizer treatments

• Cardiac monitoring

• Continuous pulse oximetry

• IV fluids without additives

• IV medications (non-chemo, non-thrombolytic)

• Preparation for complex lab tests (e.g., arterial blood gases, cultures)

• Preparation for CT, MRI, ultrasound

• Preparation for multiple X-rays

• NG tube placement

• Complex wound care (e.g., packing, multiple layers)

• Complex fracture care (splinting, manipulation without anesthesia)

• Lumbar puncture prep/assist

• Mental health crisis intervention

• Extended observation (1–2 hours)

• Multiple discharge instructions requiring moderate complexity explanation

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Potential Symptoms/Examples Which Support the Interventions

• Moderate asthma exacerbation requiring multiple nebulizers

• Chest pain with initial cardiac work-up

• Abdominal pain with lab and imaging

• Headache requiring CT scan

• Fever with abnormal labs or imaging needs

• Syncope requiring monitoring

• Complex laceration needing layered repair

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Key Notes for Coders

• Level 4 visits always involve moderate complexity in both diagnosis and treatment.

• Documentation should clearly reflect the necessity for multiple or complex interventions.

• If critical interventions (ventilation, central lines, vasopressors) are required, move to Critical Care (99291/99292) instead.

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Next in the series: ACEP ED Facility Level 5 – Maximum Resource Use.